in the brain of a woman who had died maniacal from a second attack after confinement. I have found in these cases of insanity, as well as in those arising from other causes, an effusion of albumen between the meninges; but never any substance which resembled milk. No doubt similar depositions have deceived authors. Besides, it would be as extraordinary to find milk in the cavity of the brain in these instances, as to find menstrual blood there, in mania caused by a suppression of the catamenia.

The treatment of puerperal mania has been various, and authors, without reflecting on the different causes which produce the disease, have too generally deemed it incurable. Even Puzos, after being frequently baffled in its treatment, appears to have been of this opinion, and thinks it is only to be overcome by the free and repeated employment of bleeding and purgatives. Most authors have employed the same means, and to excess, deceived, no doubt, by the violence of the symptoms and the suppression of the lochia; whereas this last symptom is by no means a constant attendant; but, on the contrary, there is sometimes a too abundant flow of this discharge. Haller relates a case of this kind; and in one of mine, the attack had been preceded for eight days by a uterine hemorrhagy. In those cases where the secretion of milk was suppressed, it was usual to endeavour to recall it by the use of purgatives, the application of cupping-glasses to the breasts, and the employment of suction. Boerhaave and Van Swieten, (Aph. 1332,) advise the cautious use of the lancet, even where the lochia are suppressed; for, say they, the risk of debilitating is greater than the advantage to be derived from the remedy. Indeed, the debility and exhaustion consequent to the puerperal state, ought to guard us against the too liberal employment of depleting remedies, and bleeding especially should be employed with the greatest caution. Even in cases of plethora, and a sanguine temperament, it would be most adviseable to have recourse to the application of leeches to the labia or thighs, and, in

general, cupping, blisters and sinapisms sometimes to the legs or thighs, in others to the back of the neck, (joined with sudorific or mild purgative ptisans, according to the state of the patient,) should be preferred to more active means. Of late, drastic purgatives have given place to laxative medicines. Some cases have been cured, merely by persisting in the daily use of purgative enemata and an antiphlogistic diet. In others, where the lymphatic temperament predominated, the repetition of emetics has been successful. Blisters are of most service in the advanced stage, when the affection has become chronic; and the same observation will apply to the use of the tepid and hot bath. A new pregnancy and nursing the child have, in some instances, removed the disease, and hence been recommended as a general means of cure; but I do not think upon good grounds; for in those cases, the cause must have been, as it were, accidental, and could not have depended on any anterior predisposing vice of habit. After the disease has continued for some time, especially in nursing women, it would be well to attempt the re-establishment of the menstrual flux, by the application of leeches to the labia, and the use of emmenagogue medicines. Attention to regimen and moral treatment are not to be neglected, although it must be confessed this last has not been so frequently attended with success as in mania from other causes.

REVIEW.

Traité de la Fièvre Jaune, par Jean Devèze, Docteur en Médecine de la Faculté de Paris, Médecin du Château des Tuileries, &c. &c. 8vo. pp. 304. Paris, chez Aimé Comte.

"JE discute une question qu'on a toujours cherché à embrouiller, et mon but est de l'eclaircir." We regret to acknowledge that a large proportion of the treatises which have appeared on the yellow fever, justifies this reproach of our author, but at the same time it gives us pleasure to admit, that his own affords internal evidence of the sincerity of that part of the remark which applies to himself. It is a lamentable fact, for which we can assign no sufficient reason, that medical doctrines are usually discussed with more irritation and acrimony than those of any other branch of natural science. It would indeed seem, as if the advocates of a medical theory identified their feelings with their subject, and staked their character on its success; while they viewed their opponents as not so much searching after truth, as engaged in a conflict for individual superiority, and the glory of giving law to the whole medical community. Passing by the various discussions on minor topics, in confirmation of our opinion, what abundant testimony do the passionate disputes, and furious contentions, which protracted the doctrinal warfare of the humorists and solidists, furnish on this point? which, while it must be confessed they benefited the cause of general science, disturbed the naturally tranquil vocation of our divine art, and represented the benefactors of mankind in the odious attitude of angry combatants. And for what? that we might learn a lesson of humility, and forbear the attempt to arrest the march of opinion in matters appertaining to a science progres

sively improving; for its light, instead of illuming, has consumed, and consigned to oblivion all the causes of their most violent controversies. The discussions on the attribute of the vaccine virus, were as rude and intemperate as any which had preceded them; but the positive and undisputed facts which time assisted to develope, were brought to bear directly on the question, while the circumscribed nature of the subject admitting of little that was conjectural, soon brought the parties to an issue, from which there was no appeal, and quickly silenced the cavillings of the interested, by establishing on an imperishable basis the utility of the discovery.

But such has not been the event in relation to the subject we are about to examine-the investigation of the origin and nature of the yellow fever does not possess these evident advantages: it necessarily leads into the wide field of doctrine concerning fevers in general, and all those diseases which are in any way connected with them-embraces such a mass of fact, often showing seeming discrepancies, and admits of so much hypothesis, and so many means of evading unwelcome results, by taking shelter under confused and ambiguous language, that no subject has more exercised the learning and ingenuity of modern disputants, or been more hotly contested, or more ably and obstinately defended. A part of all this may be attributed to the predilection of some men to defend doctrines which have been sanctioned by antiquity, although these may have arisen at a time when, comparatively speaking, the intellect was merged in ignorance, or trammelled by superstition-and a part also to the advantage which some have thought to derive, by nursing the prejudices of the public, in order, that by operating upon their fears, which are the necessary offspring of their unacquaintance with the subject, they may appear to be, not only the exclusive advocates of popular doctrines, but the only candidates for public favour. On this account it is, that in exhibiting a view of the present advanced state of

the yellow fever discussion, the few remaining advocates in this country of the barefaced illusions of human contagion, as applied to this fever, claim less indulgence than they would, under other circumstances, and with a more disinterested creed, have a right to expect.

The work before us presents peculiar claims to the candid examination of American physicians, not only as investigating a disease with which many of them are practically acquainted, and exhibiting and enforcing doctrines, which for many years they have defended, in opposition to the received theories and opinions of European writers, founded, for the most part, on the relations of others, and the forced analogies with fevers of a very different character; but as coming from a person of high professional credit and responsibility near the French monarch, and professing to give the result of his reflection and research during a period of twenty years in which he had been conversant with it-embracing fifteen years experience of its annual recurrence in the island of St. Domingo, and two of its most desolating visitations in the city of Philadelphia.

During the year 1793, the author had the medical charge of the hospital at Bush-hill, situated a short distance from the city, devoted to the reception of yellow fever patients, and he there possessed the amplest opportunities of observing the disease, and tracing its origin and propagation: they are the occurrences of that endemic more particularly which he records and elucidates in the volume before us. While we allow that this work exhibits a clear, masterly, and more comprehensive view of the origin, character, and extent of this fever, than any book which we have had the good fortune to meet with, we must remark, that we do not find him inculcating any other views, either of doctrine or practice, than those long ago ably maintained by our countrymen, Rush, Miller, Mitchill, Bayley, and others. We have not been able to obtain a copy of the author's first publication on this sub ject, and therefore cannot pretend to decide the claim of pri. ority for which he contends; but at any rate, the production